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TREATMENT
Medication Options
Thyroid treatment options and dosing are as varied as the individual patient and are dependent on the severity of the imbalance. Please see the conditions below for medication and procedure options as well as our Foundational Treatment page for optimal thyroid balance.
- Hypothyroidism and Hashimoto’s Thyroiditis
- Hyperthyroidism and Graves’ Disease
- Thyroid Cancer
TREATMENT OPTIONS
Hypothyroidism and Hashimoto’s
If a patient has low levels of thyroid hormone, then he/she is suffering from hypothyroidism. It is common for patients diagnosed with hypothyroidism, whether caused by Hashimoto’s or not, to be prescribed levothyroxine (T4) sold under various brand names.
However, many patients continue to be symptomatic on levothyroxine-only [1-6]. Therefore, treatments such as combination methods of liothyronine/levothyroxine (T3/T4), liothyronine-only (T3-only), or natural thyroid extract medication (e.g. Armour, Nature-Throid) should be considered.
Each patient must develop an individualized treatment plan with their doctor for optimal hormone replacement [1-11].
Interactions: Certain foods, drugs, and supplements can affect thyroid hormone absorption. Therefore, it is important to take thyroid medication one hour before meals, other medications, and four hours before any supplement containing iron, calcium, or zinc.
Switching Thyroid Medications: Use this conversion chart to help you find the available medication strengths, or to help you find an equivalent dose as you are switching from one medication to another.
The following treatments can be used to address hypothyroidism:
Natural Thyroid Extract
Derived from porcine thyroid gland and contains T1, T2, T3, T4, and sub-components like calcitonin.
Description
- Natural thyroid extract (NTE) is also referred to as natural thyroid (NT), natural desiccated thyroid (NDT), or desiccated thyroid extract (DTE).
- Has a T3:T4 ratio of approximately 1:4. Also contains T1 and T2, and sub-components such as calcitonin.
- Many practitioners note that NTE is a effective treatment method and is often preferred by patients with hypothyroidism [2, 6, 21-22].
Example Medication*
- Armour (US)
- Cinetic (Italy)
- Erfa (Canada)
- FegaCoren N (Germany)
- Nature-Throid (US)
- NP Thyroid (US)
- Thyreogland (Germany)
- Thyreoidum (Denmark, Netherlands)
- Thyrovanz (Int’l)
- Westhroid (US)
- Westminster (US)
- Whole Thyroid (New Zealand)
- WP Thyroid (US)
Combination T4 &/or T3
Therapies which include T4 and T3.
- Many physicians will prescribe either a brand of levothyroxine (T4) and of liothyronine (T3) or a combination product (listed) to a patient who is T3 deficient/resistant [23-24].
- Physicians may prefer unique dosage forms of T4 and/or T3 (regular or sustained-release) in custom-made, compounded formulas.
- Patients preferred combined T4/T3 therapy to usual T4 therapy. Decrease in body weight was associated with those satisfied with T4/T3 therapy [32].
Example Medication
- Compounded T4/T3
- Bitiron (Turkey)
- Cynoplus (Mexico)
- Dermocinetic (Italy)
- Dithyron (Greece)
- Ebexid (India)
- Euthyral (France)
- Jodthyrox (Austria/Russia)
- Levotrin (Argentina)
- Novothyral (Poland/Russia/Switzerland)Prothyrid (Germany)
- Somatoline (Italy)
- Thyreotom (Russia)
Liothyronine (T3)
Synthetic replication of triiodothyronine (T3), the "active" hormone.
-
- Liothyronine (T3), regular or sustained-released, can be prescribed with or without levothyroxine (T4).
T3 is readily available to every cell in the body and does not have to go through any conversion processes within the body.
Since many factors can affect the T4:T3 conversion or create thyroid resistance, lingering symptoms can often be
- resolved with T3-containing medication [23-24].
Example Medication
- Compounded T3
- Cytomel (US/Canada)
- Cynomel (Mexico/France)
- Linomel (Argentina)
- Liothyronine (US)
- Liotir (Italy)
- Neo-Tiroimade (Portugal)
- Triostat – injection (US)
- Triyotex (Mexico)
- Tertroxin (Ireland/Czech Republic)
- Triiodothyronine – injection (UK)
- Tertroxin (UK/S.Africa/Australia)
- Tojodthyronin (Austria)
Levothyroxine (T4)
Synthetic replication of thyroxine (T4), the "storage" hormone.
Most physicians will prescribe levothyroxine (T4) when a patient is diagnosed as hypothyroid.
T4 must convert to triiodothyronine (T3), the active thyroid hormone, for cellular use.
Some patients will remain symptomatic due to a conversion issue (T4 to T3), or if there is cellular thyroid resistance [2, 6, 21-22].
Example Medication
-
- Compounded T4
- Eltroxin (various countries)
- Euthyrox (various countries)
- Eutroxsig (Australia)
- Evotrox (United Kingdom)
- Letrox (various countries)
- Oroxine (Australia, Singapore)
- Synthroid (US, various countries)
- Tirosint (US, various countries)
- Thyrax (Europe, Venezuela, Philippines)
Nutrient Replacement and Supplements
Vitamin, nutrient, and supplement therapies designed to address deficiencies and root causes associated with thyroid disease.
Most thyroid patients have one or more of the following conditions present: adrenal dysfunction, sex hormone imbalances, intestinal permeability, vitamin/nutrient deficiencies, and autoimmune responses.
Many practitioners have found that by addressing these issues, autoimmune antibodies can be greatly reduced, and/or thyroid conversion issues can be significantly improved or resolved [25-27].
Example Medication
For our guide on foundational treatments and addressing root causes, click here.
TREATMENT OPTIONS
Hyperthyroidism and Graves’ Disease
Hyperthyroidism occurs when too much thyroid hormone is produced for proper functioning. The treatment of hyperthyroidism depends on the cause and severity of the disease, as well as on the patient’s age, possible goiter size, other conditions, and patient preference. The main treatment goals for hyperthyroidism, whether caused by Graves’ disease or not, are:
- to inhibit the production of thyroid hormones
- to block the effect of the hormones on the body
- to treat symptoms related to elevated heart rate [12].
The following treatments options are currently available: radioactive iodine (RAI), antithyroid drugs (ATD), or thyroidectomy [12-14]. In the U.S., radioactive iodine ablation (RAI) is often recommended as a first-line treatment. In Japan and Europe, physicians generally prefer to start with antithyroid drugs (ATDs) in the hope that the disease will remit [15-16]. Surgery, rather than RAI, is most often chosen when a patient continues to fight hyperthyroidism after being on ATDs for at least two years [18]. The long-term quality of life following treatment was found to be the same in patients randomly allocated to one of the three treatment options listed below [17].
The following treatments can be used to address hyperthyroidism:
Beta Blockers
NOTE: Beta blockers are not typically prescribed for patients with asthma because the drugs may trigger an asthma attack. They may also complicate the management of diabetes and may lower blood pressure.
Beta blockers can help with arrhythmia or tachycardia (fast heart rate) and can provide short-term relief [14].
Propanolol, with its potential to block T4 to T3 conversion, is often the first-choice option, however, others can be used [13].
Example Medication
- Acebutolol (Sectral)
- Atenolol (Tenormin)
- Bisoprolol (Zebeta)
- Metoprolol (Lopressor/Toprol-XL)
- Nadolol (Corgard)
- Nebivolol (Bystolic)
- Propranolol (Inderal LA, InnoPran XL)
Anti-thyroid Medication (thionamides)
NOTE: Best used for patients with less severe cases of hyperthyroidism. A small number of people who are allergic to these drugs may develop skin rashes, hives, fever or joint pain. Increased infection may also occur.
- Reduces symptoms of hyperthyroidism by preventing the over-production of thyroid hormones [15].
- Typically, the first line of treatment in Europe and Japan. Has the possibility to restore normal thyroid levels. Does not permanently damage the gland [15-16].
- Symptoms usually begin to improve in 6 to 12 weeks, but treatment typically continues at least a year and often longer [28].
Example Medication
- Methimazole
- Propylthiouracil (PTU)
- Carbimazole
Radioactive Iodine Therapy (RAI-131 or RAI)
NOTE: Graves’ opthalmopathy can develop or be worsened by the use of radioactive iodine in 15 percent of patients and corticosterioids have been found to greatly reduce this incidence [20].
- Typically, the first line of treatment in the USA. RAI destroys the tissue of the overactive thyroid or shrinks it if it has a goiter [15-16].
- Approximately 90% of patients need one dose of RAI to eliminate thyroid hormone over-production. Takes about 1 month to reduce symptoms and may take up to 6 months before RAI fully destroys all or part of the thyroid [28].
- After RAI, many patients are then considered “hypothyroid” and will need thyroid replacement medication which is discussed in the above section.
Example Medication
Administered orally via capsule or liquid form.
NOTE: Patients need to be in isolation for at least 72 hours after treatment is administered since they are emitting radiation. Individuals and/or animals exposed to this ambient radiation are susceptible to thyroid destruction [28].
Thyroidectomy
NOTE: Partial or total removal of the thyroid gland; considered for the small percentage of patients who are allergic to antithyroid medications, who are resistant to radioactive iodine, or who have a hot nodule.
- A subtotal thyroidectomy, performed most commonly, allows some of the thyroid tissue to be preserved, thus reducing the incidence of hypothyroidism to 25%. Persistent or recurrent hyperthyroidism occurs in 8% of patients [14].
- A total thyroidectomy is reserved for patients with severe disease, large goiters, or nodules that may be concerning of cancer. Carries an increased risk of hyperparathyroidism and laryngeal nerve damage [14].
- Once part or all of the thyroid is removed, the patient is normally considered “hypothyroid” and will need replacement medication as indicated above.
Example Medication
NOTE: It is highly recommended to investigate multiple surgeons skilled in thyroid gland removal to minimize possible complications such as collateral damage to parathyroid glands.
Nutrient Replacement and Supplements
Vitamin, nutrient, and supplement therapies designed to address deficiencies and root causes associated with thyroid disease.
- Most thyroid patients have one or more of the following conditions present: adrenal dysfunction, sex hormone imbalances, intestinal permeability, vitamin/nutrient deficiencies, and autoimmune responses.
- Many practitioners have found that by addressing these issues, autoimmune antibodies can be greatly reduced, and/or thyroid conversion issues can be significantly improved or resolved [25-27].
Example Medication
For our guide on foundational treatments and addressing root causes, click here.
TREATMENT OPTIONS
Thyroid Cancer Treatment
Thyroid cancer has various forms and treatment is dependent on the individual case. The most common form of thyroid cancer in the United States is papillary thyroid cancer, followed by follicular thyroid cancer. The least common are medullary and anaplastic thyroid cancer. Each name indicates where the cancer is located within the thyroid gland [19]. If diagnosed and treated early, thyroid cancer treatment can be effective and usually includes the options listed below.
Due to the individual nature of cancer staging and treatment, patients must work closely with their doctors to create a personalized treatment plan.
The effectiveness of thyroid cancer treatment lends itself to the reputation of being a “good cancer” to have, however, any cancer should not be minimized. Thyroid cancer needs effective treatment and on-going monitoring. For more information about the how the thyroid works and the specifics of thyroid disorders, including thyroid cancer, please see our About Thyroid Disease page.
The following options can be used to address thyroid cancer:Radioactive Iodine Therapy (RAI-131 or RAI)
NOTE: Graves’ opthalmopathy can develop or be worsened by the use of radioactive iodine in 15 percent of patients and corticosterioids have been found to greatly reduce this incidence [20].
- Whether RAI is recommended depends upon many factors with tumor staging and is usually not recommended for low-risk patients and/or certain types of cancers [29].
- RAI may be administered weeks after surgery to eliminate (ablate) any remaining thyroid cells that could not be removed [28].
- As a result of the thyroid cell destruction from RAI, many patients are then considered “hypothyroid” and will need thyroid replacement medication which is discussed in the above section.
Example Medication
Administered orally via capsule or liquid form.
NOTE: Patients need to be in isolation for at least 72 hours after treatment is administered since they are emitting radiation. Individuals and/or animals exposed to this ambient radiation are susceptible to thyroid destruction.
Thyroidectomy
NOTE: Partial or total removal of the thyroid gland; considered for the small percentage of patients who are allergic to antithyroid medications, who are resistant to radioactive iodine, or who have a hot nodule.
- A total or partial thyroidectomy removes and prevents the spread of cancerous cells by removing part or all of the thyroid gland. It is sometimes followed by radioactive iodine (RAI), also known as I-131 [30].
- Total thyroidectomy is the main treatment for medullary thyroid carcinoma. However, a total thyroidectomy has an increased risk of hyperparathyroidism and laryngeal nerve damage [14].
- Once part or all of the thyroid is removed, the patient is normally considered “hypothyroid” and will need replacement medication as indicated above.
Example Medication
NOTE: It is highly recommended that the patient find a surgeon skilled in thyroid gland removal to minimize complications such as collateral damage to your parathyroid glands.
External Beam Radiation
- Therapy which uses high energy particles (or rays) in an effort to kill or slow cancer cells in cancers that do not uptake iodine, such as medullary and anaplastic [31].
- If a cancer does not respond to RAI, reoccurs, or is a distant metastasis, external beam radiation therapy may by used [31].
- This therapy, unlike RAI, does not target thyroid cells and can destroy other healthy tissue cells along with cancer cells [31].
Example Medication
NOTE: To reduce the risk of side effects, doctors carefully calculate the placement of the beam on the target area and the least amount of radiation needed to be effective.
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